A Surgeon That Switched to Unrestricted Kinematic Alignment with Manual Instruments Has a Short Learning Curve and Comparable Resection Accuracy and Outcomes to Those of an Experienced Surgeon
After starting an orthopedic practice, a surgeon with a fellowship in mechanically aligned (MA) TKA initiated this study to characterize their learning curve after they switched to unrestricted kinematic alignment (KA) TKA using manual instruments. Accordingly, the present study determined for the i...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-07-01
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| Series: | Journal of Personalized Medicine |
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| Online Access: | https://www.mdpi.com/2075-4426/12/7/1152 |
| _version_ | 1797405886291902464 |
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| author | Alexander J. Nedopil Anand Dhaliwal Stephen M. Howell Maury L. Hull |
| author_facet | Alexander J. Nedopil Anand Dhaliwal Stephen M. Howell Maury L. Hull |
| author_sort | Alexander J. Nedopil |
| collection | DOAJ |
| description | After starting an orthopedic practice, a surgeon with a fellowship in mechanically aligned (MA) TKA initiated this study to characterize their learning curve after they switched to unrestricted kinematic alignment (KA) TKA using manual instruments. Accordingly, the present study determined for the inexperienced (IE) surgeon the number of cases required to achieve consistent femoral resections and operating times, and whether the femoral resection accuracy, patient-reported outcome measures (PROMs), and component alignment were different from an experienced (E) surgeon. This prospective cohort study analyzed the IE surgeon’s first 30 TKAs, all performed with KA, and 30 consecutive KA TKAs performed by an E surgeon. The resection accuracy or deviation was the calipered thickness of the distal and posterior medial and lateral femoral resections minus the planned resection thickness, which was the thickness of the corresponding condyle of the femoral component, minus 2 mm for cartilage wear, and 1 mm for the kerf of the blade. Independent observers recorded the femoral resection thickness, operative times, PROMs, and alignment. For each femoral resection, the deviation between three groups of patients containing ten consecutive KA TKAs, was either insignificant (<i>p</i> = 0.695 to 1.000) or within the 0.5 mm resolution of the caliper, which indicated no learning curve. More than three groups were needed to determine the learning curve for the operative time; however, the IE surgeon’s procedure dropped to 77 min for the last 10 patients, which was 20 min longer than the E surgeon. The resection deviations of the IE and E surgeon were comparable, except for the posterolateral femoral resection, which the IE surgeon under-resected by a mean of −0.8 mm (<i>p</i> < 0.0001). At a mean follow-up of 9 and 17 months, the Forgotten Joint Score, Oxford Knee Score, KOOS, and the alignment of the components and limbs were not different between the IE and E surgeon (<i>p</i> ≥ 0.6994). A surgeon that switches to unrestricted KA with manual instruments can determine their learning curve by computing the deviation of the distal and posterior femoral resections from the planned resection. Based on the present study, an IE surgeon could have resection accuracy, post-operative patient outcomes, and component alignment comparable to an E surgeon. |
| first_indexed | 2024-03-09T03:16:42Z |
| format | Article |
| id | doaj.art-296cf2a2c4414c83bda796a572cdd46e |
| institution | Directory Open Access Journal |
| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-09T03:16:42Z |
| publishDate | 2022-07-01 |
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| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-296cf2a2c4414c83bda796a572cdd46e2023-12-03T15:17:01ZengMDPI AGJournal of Personalized Medicine2075-44262022-07-01127115210.3390/jpm12071152A Surgeon That Switched to Unrestricted Kinematic Alignment with Manual Instruments Has a Short Learning Curve and Comparable Resection Accuracy and Outcomes to Those of an Experienced SurgeonAlexander J. Nedopil0Anand Dhaliwal1Stephen M. Howell2Maury L. Hull3Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität, 97074 Würzburg, GermanyCollege of Medicine, California Northstate University, Elk Grove, CA 95757, USADepartment of Biomedical Engineering, University of California, Davis, CA 95616, USADepartment of Biomedical Engineering, University of California, Davis, CA 95616, USAAfter starting an orthopedic practice, a surgeon with a fellowship in mechanically aligned (MA) TKA initiated this study to characterize their learning curve after they switched to unrestricted kinematic alignment (KA) TKA using manual instruments. Accordingly, the present study determined for the inexperienced (IE) surgeon the number of cases required to achieve consistent femoral resections and operating times, and whether the femoral resection accuracy, patient-reported outcome measures (PROMs), and component alignment were different from an experienced (E) surgeon. This prospective cohort study analyzed the IE surgeon’s first 30 TKAs, all performed with KA, and 30 consecutive KA TKAs performed by an E surgeon. The resection accuracy or deviation was the calipered thickness of the distal and posterior medial and lateral femoral resections minus the planned resection thickness, which was the thickness of the corresponding condyle of the femoral component, minus 2 mm for cartilage wear, and 1 mm for the kerf of the blade. Independent observers recorded the femoral resection thickness, operative times, PROMs, and alignment. For each femoral resection, the deviation between three groups of patients containing ten consecutive KA TKAs, was either insignificant (<i>p</i> = 0.695 to 1.000) or within the 0.5 mm resolution of the caliper, which indicated no learning curve. More than three groups were needed to determine the learning curve for the operative time; however, the IE surgeon’s procedure dropped to 77 min for the last 10 patients, which was 20 min longer than the E surgeon. The resection deviations of the IE and E surgeon were comparable, except for the posterolateral femoral resection, which the IE surgeon under-resected by a mean of −0.8 mm (<i>p</i> < 0.0001). At a mean follow-up of 9 and 17 months, the Forgotten Joint Score, Oxford Knee Score, KOOS, and the alignment of the components and limbs were not different between the IE and E surgeon (<i>p</i> ≥ 0.6994). A surgeon that switches to unrestricted KA with manual instruments can determine their learning curve by computing the deviation of the distal and posterior femoral resections from the planned resection. Based on the present study, an IE surgeon could have resection accuracy, post-operative patient outcomes, and component alignment comparable to an E surgeon.https://www.mdpi.com/2075-4426/12/7/1152total knee arthroplastykinematic alignmentlearning curveaccuracyefficiency |
| spellingShingle | Alexander J. Nedopil Anand Dhaliwal Stephen M. Howell Maury L. Hull A Surgeon That Switched to Unrestricted Kinematic Alignment with Manual Instruments Has a Short Learning Curve and Comparable Resection Accuracy and Outcomes to Those of an Experienced Surgeon Journal of Personalized Medicine total knee arthroplasty kinematic alignment learning curve accuracy efficiency |
| title | A Surgeon That Switched to Unrestricted Kinematic Alignment with Manual Instruments Has a Short Learning Curve and Comparable Resection Accuracy and Outcomes to Those of an Experienced Surgeon |
| title_full | A Surgeon That Switched to Unrestricted Kinematic Alignment with Manual Instruments Has a Short Learning Curve and Comparable Resection Accuracy and Outcomes to Those of an Experienced Surgeon |
| title_fullStr | A Surgeon That Switched to Unrestricted Kinematic Alignment with Manual Instruments Has a Short Learning Curve and Comparable Resection Accuracy and Outcomes to Those of an Experienced Surgeon |
| title_full_unstemmed | A Surgeon That Switched to Unrestricted Kinematic Alignment with Manual Instruments Has a Short Learning Curve and Comparable Resection Accuracy and Outcomes to Those of an Experienced Surgeon |
| title_short | A Surgeon That Switched to Unrestricted Kinematic Alignment with Manual Instruments Has a Short Learning Curve and Comparable Resection Accuracy and Outcomes to Those of an Experienced Surgeon |
| title_sort | surgeon that switched to unrestricted kinematic alignment with manual instruments has a short learning curve and comparable resection accuracy and outcomes to those of an experienced surgeon |
| topic | total knee arthroplasty kinematic alignment learning curve accuracy efficiency |
| url | https://www.mdpi.com/2075-4426/12/7/1152 |
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